No Difference in Survival for R1 Resections: Could There Be a Role for Debulking Surgery for Colorectal Liver Metastases?

Aims: To determine whether there is a role for debulking surgery in colorectal liver metastases (CRLM) by comparing results for those with and without a positive resection margin. Methods: A prospective database of all patients undergoing resection for CRLM in a single centre between 2003–2013 was reviewed retrospectively. Data included resection margin (<1mm considered positive), size of tumour, number of tumours, time from colorectal resection (CRR), positive nodes at CRR and use of adjuvant or neoadjuvant chemotherapy for liver metastases. Primary outcome was local recurrence. Distant recurrence and overall survival was also recorded. All patients were followed-up for a minimum 6 months. Results: 270 patients (65.9% male, median age 67 years) underwent resection for CRLM in 11 years. 54 (20.1%) had positive margin (R < 1mm). Recurrence occurred in 75.0% with positive margin compared with 55.7% with negative margin. Local recurrence occurred in 46.0% of those with positive margin compared with 27.3% with negative margin. Disease-free survival was significantly longer in those with a negative margin (p = 0.026). However on multivariate analysis there was not a significant difference (p = 0.062). The only factors that were independently significant were number of metastases and tumour size. There was no difference in overall survival between the two groups (p = 0.282). Conclusions: We found that there was a difference in local and overall recurrence between patients with a positive resection margin and those without. However this was not significant when other factors were considered. There was no significant difference in overall survival. With advances in systemic treatment there may be a role for debulking liver surgery in chemotherapy-responsive patients, although more trials are needed.